A Carolina Reaper Pepper Sent a Man to the Hospital With ‘Thunderclap’ Headaches

It’s the first report of this kind of thing happening.

The Carolina Reaper is the hottest chili pepper in the world, according to Guinness World Records: In terms of sheer spiciness, it measures in at an average 1.6 million on the Scoville heat scale (a jalapeno, by comparison, is typically under 10,000).

While there have been reports of other up-and-comers, including the fearsomely named “Pepper X,” unseating the Carolina Reaper, it’s still not a pepper to be trifled with. This is made clear in a new paper published in BMJ Case Reports, which describes how an otherwise healthy 34-year-old man sent himself to hospital with “thunderclap headaches” after downing a single Carolina Reaper in a hot pepper eating contest.

“Immediately after eating the pepper, he started having pain,” Dr. Kulothungan Gunasekaran, one of the study authors, told me over the phone. The man experienced dry heaving, severe neck pain, and bouts of crippling head pain, each lasting just a few seconds, over many days—so-called “thunderclap headaches.” He eventually went to the emergency room.

“He underwent an extensive workup, and they couldn’t find the reason,” said Gunasekaran, a senior staff physician at Henry Ford Hospital in Detroit. The patient finally was given a CT scan, which showed that several arteries in his brain had narrowed. Doctors diagnosed him with reversible cerebral vasoconstriction syndrome (RCVS)—temporary artery narrowing in the brain that can bring on intense, sudden headaches. Lucky for him, RCVS typically resolves on its own.

So what happened here?

Gunasekaran explained that, as this is the first description of such a thing in the medical literature, there haven’t been any randomized controlled trials, which are the “gold standard” of clinical research. So it’s hard to know exactly why eating the pepper would be associated with this effect. Other small studies have suggested that capsaicin—which is basically what makes peppers spicy—can potentially cause blood vessels to spasm. “Two [previous] case reports showed that capsaicin could cause blood vessel narrowing in the heart,” he said.

It’s possible that, in this case, something similar happened in the patient’s brain arteries. The patient’s symptoms went away with the help of pain medication and other supportive care. In rare cases, blood vessel constriction in the brain can cause a stroke, Gunasekaran added, although that hasn’t been documented in a case involving spicy pepper eating.

Gunasekaran recommended that, if you start having acute head or chest pain after eating a particularly hot pepper, you should seek out urgent medical care. Whether genetics or other factors make some people susceptible to this kind of effect is unknown.

Now, if you’re someone who enjoys eating hot peppers, you don’t need to worry. Plenty of people eat spicy food all the time and encounter no negative consequences, other than what you’d expect—burning mouth and throat, heartburn, watering eyes, “abdominal distress,” and so forth. Other research has suggested ingesting hot peppers can be good for you.

Even medical professionals do it. “I was discussing this case with one of my nurses. He said he participated in those [spicy pepper eating] games, and he did well,” Gunasekaran told me. Just be careful out there: If the Carolina Reaper can potentially cause thunderclap headaches and dry heaving, imagine what a Dragon’s Breath could do.

Correction: This story initially misidentified the pepper as a "California Reaper." Motherboard regrets the error.